Abstract: China has limited environmental capacity and fragile ecosystems. The ecological and environmental situation characterized by heavy pollution, significant losses, and high risks has not yet been fundamentally reversed. As a vital component of the 'urban organism', urban ecosystems urgently require systematic health management assessments to address prominent urban ecological issues and improve both regional ecological environments and the quality of urban and rural living environments. This study focuses on the assessment indicators and management systems for urban ecosystem health. Through a comprehensive review and analysis of relevant literature, it systematically synthesizes indicator systems from environmental issues, urban health examinations, planning monitoring, and specialized evaluations in the field of ecological environment at home and abroad. Taking arid-region cities in China as case studies, the study covers the full life-cycle processes of ecological constructionincluding planning and design, construction, operation and maintenance, and management-and constructs a '4916' health management indicator system that integrates qualitative and quantitative approaches, along with a 'sixstep' framework for urban ecosystem health management. Ultimately, starting with the urban diseases of aridregion urban ecosystems, the study conducts health diagnostics, evaluates the health levels of urban ecosystems, and proposes scientifically sound governance strategies and specific measures.